Provider Demographics
NPI:1952048399
Name:ONGCHUAN, KRISTINE (DMD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:ONGCHUAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:ONGCHUAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2220 MEADOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2236
Practice Address - Country:US
Practice Address - Phone:919-827-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice